Annals of Surgical Treatment and Research最新文献

Purpose: Postoperative delirium (POD) is a frequent acute cognitive disorder that occurs after surgery. Enhanced recovery after surgery (ERAS) has been suggested to decrease its incidence. Due to the lack of conclusive evidence on the topic, we conducted a meta-analysis to investigate the potential impact of ERAS on POD.

Methods: We included randomized controlled trials involving adult patients undergoing elective surgery. The ERAS group received management based on ERAS principles during the perioperative period, while the control group implemented traditional management strategies. The major evaluation indicators included the incidence of POD, the timing of its first occurrence, and the duration of POD. The secondary evaluation indicators were the content of Mini-Mental State Examination (MMSE) scores, the time to first ambulation, total complication rates, and length of hospital stay.

Results: The results indicated that ERAS significantly reduced the overall incidence of POD (relative risk [RR] = 0.38, P < 0.00001) and the incidence of delirium on the first and second postoperative days (RR = 0.20, P = 0.03; RR = 0.21, P = 0.01). It also delayed the first occurrence of POD (mean difference [MD] = -1.5, P < 0.0001), reduced its duration (MD = -2.15, P = 0.005), improved MMSE scores (MD = 1.95, P < 0.00001), sped up ambulation (MD = -1.53, P < 0.00001), decreased total complication rates (RR = 0.21, P = 0.0003), and shortened hospital stays (MD = -4.61, P < 0.00001).

Conclusion: In conclusion, ERAS significantly reduces POD and related complications while facilitating rapid recovery in surgical patients.

Purpose: Papillary thyroid cancer (PTC), a common malignancy among women of reproductive age, is increasingly common during pregnancy because of routine prenatal imaging. However, the optimal timing for surgical treatment remains controversial. This study aimed to assess the safety and practicality of performing thyroid surgery during pregnancy through a comparative analysis of perioperative and pathological outcomes between pregnant and nonpregnant women.

Methods: We conducted a retrospective case-control study of 100 female patients aged 20-39 years who underwent thyroid surgery for PTC between January 2019 and December 2024. Patients were grouped into pregnant (n = 14) and nonpregnant (n = 86) cohorts. Clinical, surgical, and pathological data were compared.

Results: Most pregnant patients underwent surgery during the second trimester. The operative duration was significantly shorter in the pregnant group than in the nonpregnant group (71.4 ± 26.35 minutes vs. 87.2 ± 5.17 minutes, P = 0.025), and there was a trend towards a lower drain volume on postoperative day 1 (25.2 ± 15.23 mL vs. 32.7 ± 0.18 mL, P = 0.077). No significant differences were observed in terms of complication rates. Despite a higher frequency of extrathyroidal extension (P = 0.003) and advanced T stage (P = 0.038) in the pregnant group, the surgical outcomes were favorable. One neonate experienced mild intraventricular hemorrhage that resolved without sequelae.

Conclusion: Thyroid surgery during pregnancy, particularly in the second trimester, appears feasible in selected patients. Given the small sample and retrospective nature of this study, larger prospective studies are needed to validate these findings.

Purpose: The BRAF^V600E mutation is a common genetic alteration in papillary thyroid carcinoma (PTC) and is associated with poor prognostic factors. Accurate detection is crucial for risk stratification. This study compares the performance of direct Sanger sequencing (SS), immunohistochemistry (IHC), and droplet digital PCR (ddPCR) in detecting the BRAF^V600E mutation in PTC.

Methods: Tumor samples from patients undergoing thyroidectomy were analyzed for BRAF^V600E using SS, IHC, and ddPCR. A mutant allele fraction >1% was considered ddPCR positive. Sensitivity and concordance rates were evaluated.

Results: A total of 48 PTC and 9 benign samples were tested. All benign samples were negative for BRAF^V600E by both SS and ddPCR. Among PTC cases, the mutation was detected in 72.9% by SS, 89.6% by IHC, and 83.3% by ddPCR. Both IHC and ddPCR were significantly more sensitive than SS (P = 0.001 and P < 0.001, respectively). Concordant results across all 3 methods were seen in 83.3% of PTC cases. Among the 8 discordant samples (all SS-negative), 5 were positive by both IHC and ddPCR, and 3 were IHC-positive only. Of these, 6 showed adenine peaks on SS chromatograms, with a mean ddPCR mutant allele fraction of 14.5%, compared to 0.36% in the 2 without adenine peaks.

Conclusion: IHC and ddPCR demonstrated superior sensitivity compared to SS for detecting BRAF^V600E mutations in PTC. These findings support the use of IHC and ddPCR as more reliable alternatives to SS in clinical practice.

Purpose: Accurate data collection and analysis are crucial in clinical research, particularly for extracting information from unstructured medical records in cancer research. Traditional methods often struggle with this task. Large language models (LLMs) specializing in natural language processing (NLP), like ChatGPT (OpenAI), show potential for automating this process. This study evaluated whether GPT-4 could accurately extract clinical stages of colorectal cancer (CRC) from imaging reports.

Methods: Using specific prompts based on the American Joint Committee on Cancer TNM staging system, GPT-4 was tested on the unstructured abdominal imaging reports of 100 CRC patients. The results were evaluated by a colorectal surgical oncologist and compared with data manually extracted by a nonspecialist data manager.

Results: GPT-4 demonstrated high accuracy in extracting lesion locations (96.0%) and T (89.0%), N (90.0%), and M (85.0%) stages, with an overall TNM stage extraction accuracy of 69.0%. The combined accuracy for TNM stage and lesion location was 67.0%. Human data managers had similar TNM stage accuracy but lower lesion-location accuracy (76.0%). Higher accuracy was observed when reports directly mentioned stages and were in English only.

Conclusion: This study confirms that LLM-based NLP, with proper prompt engineering, can accurately extract clinical stages from CRC imaging reports, particularly in English-only contexts.

Purpose: Single-port robotic platforms represent an emerging approach in head and neck surgery, yet their comparative effectiveness against traditional multiport systems remains unclear.

Methods: A systematic review of PubMed, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov was conducted from inception to January 17, 2025. From 93 potentially relevant articles, 5 retrospective comparative studies met the inclusion criteria, comprising 1,000 patients (single-port, 453; multiport, 547). Random-effects meta-analysis was performed for operative parameters.

Results: Single-port surgery demonstrated shorter docking times (pooled effect size, -1.05; 95% confidence interval [CI], -1.47 to -0.64) with moderate heterogeneity (I² = 74.27%). Console times showed no significant difference between approaches (effect size, -0.05; 95% CI, -0.35 to 0.25). Total operative times, reported in 2 studies, indicated modest reductions with the single-port approach (295 ± 92 minutes vs. 315 ± 101 minutes; 101.9 ± 23.6 minutes vs. 114.9 ± 32.8 minutes). Major complication rates were comparable (single-port, 1.8%-9.7%; multiport, 2.7%-4.3%). Negative margin rates favored single-port procedures (57%-100% vs. 48%-92.6%).

Conclusion: This systematic review suggests that single-port robotic surgery offers advantages in docking time while maintaining comparable safety profiles to multiport approaches in head and neck procedures. However, the quality of evidence remains low due to the observational nature of available studies and heterogeneity in outcome reporting.

Purpose: This study was performed to analyze whether adjuvant radiotherapy (RT) can improve the survival outcome for pathological node-negative (ypN0) breast cancer patients who underwent surgery after neoadjuvant chemotherapy (NAC).

Methods: In this meta-analysis, we reviewed papers related to adjuvant RT in ypN0 patients after NAC published between January 2010 and November 2024 using PubMed, EMBASE via Elsevier, Cochrane Library with keywords: "breast neoplasms," "neoadjuvant therapy," and "radiotherapy." The effectiveness of post-mastectomy RT (PMRT) after mastectomy and regional nodal irradiation (RNI) after breast-conserving surgery (BCS) was evaluated. The end point of this study was overall survival (OS).

Results: We selected 11 retrospective papers for this meta-analysis out of 4,164 English full-text articles. There were 7 PMRT-related and 5 RNI-related papers (1 duplicated) for final analysis. Overall, PMRT in ypN0 patients improved OS (hazard ratio [HR], 0.862; 95% confidence interval [CI], 0.766-0.972; P = 0.015) after mastectomy. Moreover, OS (HR, 0.774; 95% CI, 0.600-0.999; P = 0.049) was also improved by RNI for ypN0 patients after BCS.

Conclusion: For patients with ypN0 breast cancer who have undergone NAC and surgery, PMRT positively affected the survival outcome of patients. Therefore, it is necessary to undergo adjuvant RT to improve survival for ypN0 breast cancer patients.

Purpose: Endophytic gastric subepithelial tumors (SETs), especially those near the gastroesophageal junction (GEJ), present challenges in localization and resection. This study aimed to compare the outcomes of single-incision intragastric wedge resection (SIWR) and conventional multiport laparoscopic wedge resection (CWR) for endophytic gastric SETs, including a subgroup analysis of tumors located near the GEJ.

Methods: This retrospective, single-center study included 124 patients who underwent laparoscopic wedge resection for endophytic gastric SETs between January 2016 and December 2024. Operative and postoperative outcomes were compared between the SIWR (n = 23) and CWR (n = 101) groups. Subgroup analysis was performed for tumors located within 2 cm of the GEJ.

Results: The mean tumor size was smaller in the SIWR group than in the CWR group (2.03 ± 0.97 cm vs. 2.57 ± 1.14 cm, P = 0.038). The SIWR group showed a longer postoperative hospital stay (6.30 ± 6.55 days vs. 4.89 ± 1.29 days, P = 0.045) and a higher complication rate (21.7% vs. 4%, P = 0.003), but a shorter time to oral intake (1.43 ± 0.95 days vs. 1.98 ± 0.98 days, P = 0.016). In the GEJ subgroup, SIWR was more commonly performed and showed a shorter time to oral intake without increasing early complications. Late complications were observed only in the CWR group.

Conclusion: Both CWR and SIWR are feasible approaches for endophytic gastric SETs. SIWR may be preferable in selecting GEJ-proximal cases but requires cautious application due to its higher complication rate.

Purpose: Various materials and techniques have been explored to prevent anastomotic leakage (AL). Polyglycolic acid (PGA) sheets and cyanoacrylate (CA) glue have been investigated for their potential in wound healing and fistula closure. This study aims to assess the feasibility of PGA-CA complex (PCC) to prevent AL by developing a major leakage model in rats.

Methods: After the creation of the major leakage model in the jejunum of rat, the leakage site was treated with each material individually and in combination. Rats were categorized into the control, CA, PGA, and PCC groups.

Results: A total of 40 rats were included, with one animal from the CA and PGA groups having expired. Gross intra-abdominal conditions showed no significant difference between the groups. Median intraluminal bursting pressure was 120.0 (range, 102.5-138.0) in the CA group and 138.0 (range, 127.0-147.0) in the PCC group (P = 0.286). Pathologic evaluation revealed fibroblast activation was significantly different in the PCC group (P = 0.025).

Conclusion: No significant differences were observed in the macroscopic intra-abdominal findings or intraluminal bursting pressure between the groups. The only difference in PCC group was enhanced fibroblast activation at moderate levels compare to the control group. Further research is warranted to optimize material combinations and validate efficacy in larger preclinical and clinical settings.

Purpose: The quality of kidneys from deceased donors is critical for successful kidney transplantation. Due to donor shortages, expanded criteria donors are increasingly used, raising concerns about posttransplant outcomes. This study evaluated the predictive value of donor aortoiliac calcification on graft outcomes to improve donor assessment and transplant planning.

Methods: This retrospective study analyzed pretransplant non-contrast CT scans to classify donor aortoiliac calcification as non-to-mild or moderate-to-severe (MTS). Donor and recipient characteristics, time-zero biopsy findings, and graft outcomes were compared using chi-square tests and logistic regression.

Results: MTS donors were significantly older (58.2 ± 5.2 years vs. 49.7 ± 12.8 years, P = 0.002), had more diabetes mellitus (50.0% vs. 10.0%, P = 0.004), and higher Kidney Donor Profile Index (KDPI) scores (79.0 ± 15.2 vs. 59.4 ± 25.1, P = 0.001). Tubular atrophy (TA) was more frequent in the MTS group (81.8% vs. 46.7%, P = 0.022). Logistic regression showed donor diabetes mellitus (β = 0.496, P = 0.001) and Banff TA (β = 0.431, P = 0.003) were significant predictors of calcification.

Conclusion: Aortoiliac calcification in deceased donors is associated with older donor age, higher KDPI scores, and increased incidences of diabetes mellitus and TA. Although it correlated with donor-related risk factors known to influence graft outcomes, it did not independently predict graft function or survival. Therefore, its role in donor selection appears limited and warrants further validation through larger prospective studies.